Surgery is the treatment of choice of symptomatic tracheal obstruction due to malignant thyroid disease. Few additional therapeutic alternatives are available: Radiotherapy (RT), chemotherapy (CT) or radio-iodine therapy (131-I). Only few studies on interventional bronchoscopic procedures (IBP) as alternative procedures are reported so far. This study is a retrospective report of results of IBP performed in patients with severe tracheal obstruction due to thyroid cancer.
Since 1/1/2000 to 31/3/2004 14 consecutive patients (5 males, mean age: 62.2 yrs) underwent IBP due to tracheal obstruction for anaplastic (ATC : 7 patients), differentiated (DTC : 5), medullary (MTC : 1) and non epithelial malignant (NEMN: 1) thyroid cancer. 8/14 had local advanced inoperable disease ab initio, 6/14 had local relapse after surgery, 131-I or RT. Ten patients out of 14 were submitted to IB for severe dyspnoea. In 4 patients airways patency was maintained by insertion of a stent; in 3 the tracheal neoplasm was removed by Nd-YAG laser, in 7 both procedures were performed.
All 10 patients with dyspnoea showed an improvement of symptom. Early and late complications were observed in 4 and in 3 patients respectively. All but 4 DTC patients died 11.9 ± 14.2 months after the diagnosis (4.20 ± 5.1 after IB). In 4 DTC patients still alive at follow up, 90.7 + 59.2 months since diagnosis and 16.7 + 9.2 since IB; the airways dilatations allowed following treatment like 131-I and/or RT.
Interventional bronchoscopy, including Nd-YAG laser and airways stenting are alternatives to surgery in inoperable thyroid –induced tracheal obstruction. Moreover, the airway dilatation improve the dyspnea and allowed successive treatment.
Interventional bronchoscopy should be considered as an option in the comprehensive treatment of thyroid cancer.
N. Ambrosino, None.